<p> RSCDS INTERNATIONAL BRANCH SCD WEEKEND IN PRAGUE 10-13 JUNE 2011</p><p>APPLICATION FORM (one per person) PLEASE PRINT</p><p>Name: </p><p>Address: Town: Country: Postcode: Telephone: E-mail: IB-membership number: Contact in case of emergency: To help us organise the classes, please supply the following information: Age:  under 20  20-40  40-60  over 60 I have been dancing since: I am interested in:  technique  social dancing</p><p>Due to the current currency fluctuations, the sterling price will be monitored and changed if necessary - if you are paying in pound sterling, please e-mail us at [email protected] before you pay.</p><p>Please tick as applicable Price Basic workshop package  €110/£92 (classes, three evening dances, tour of Prague)  IB member: €100/£84 Non-dancer package (tour of Prague, admission to the evenings)  €20/£17  sharing a double/twin: €170/£143 Accommodation at Hotel Beranek (includes all meals)  single room: €240/£201 TOTAL WORKSHOP TO PAY</p><p>1 I would like to share a room with ...... and would prefer a  quiet room  party room  no preference</p><p>My dietary requirements are: …………………………………….</p><p>I will be travelling by air/rail/sea/road, arriving in Prague on (date) …………………at (time) ………………..…</p><p>2 Please also let us know if you require information about:</p><p> Non-dancing package during the workshop  Accommodation before the workshop  The sightseeing/dancing holiday organised by Dvorana from 13-18 June 2011  Anything else we can help you with</p><p>How to pay</p><p>Important! Please note that all transfer charges must be paid by the applicant. Don’t forget to mention “Prague 2011”, your name, and the names of anyone else included in the payment.</p><p>By bank transfer to our Euro account: The International Branch of the RSCDS Banque et Caisse d’Epargne de l’État, Luxembourg IBAN account number: LU05 0019 1955 4239 6000 BIC code: BCEELULL</p><p>By bank transfer to our sterling account: The International Branch of the RSCDS Royal Bank of Scotland Account number: 00621190 Sort code: 83-17-23</p><p>By sterling cheque drawn on a UK bank: Please make the cheque payable to the International Branch of the RSCDS and post it together with this application form to: Susi Mayr, Bergsteiggasse 7/3/17, A-1170 Vienna, Austria</p><p>By PayPal: Please send you payment to the following email address: [email protected]</p><p>Please note that a non-refundable deposit of €50/£42 is due together with the application form by 31 January 2011. Places will not be confirmed until the non-refundable deposit has been received. Balance of fees is due by 30 April 2011. 50% of the fee paid (minus the deposit) will be refunded for cancellations made by 31 May 2011. No refunds will be made for cancellations after 31 May 2011.</p><p>Grand total due  bank transfer  cheque Total remitted with this application  PayPal (please tick all that apply)  deposit only  full fee Total due by 30 April 2011 </p><p>I understand that the International Branch of the RSCDS is under no liability whatsoever in respect of any personal injury or loss which I may sustain and I agree to conform to any rules or regulations which may be made from time to time and which govern my visit to the Prague IB workshop and sightseeing programme.</p><p>Signed: ______Date: ______</p><p>3 4</p>